Transcript

Bryan Mendelson: You know, when you operate and you get down into the facial spaces - you feel like you’re an explorer. You’re the first person who’s ever been there. And then you gently probe your way through and with all the experience and the techniques, you just open up these spaces in front of your eyes. It’s a beautiful thing.

Amanda Smith: That’s a plastic surgeon’s view of a facelift from the inside, under the skin.

Hello I’m Amanda Smith and this is The Body Sphere – looking you in the face in this program. Have you, would you change your face surgically?

Things like facelifts and nose jobs, having your lips juiced up and eyes widened is increasingly popular mostly for women but also for men, and not just in western countries: in parts of Asia, South America and the Middle East as well. And later in The Body Sphere the sociologist Anthony Elliott will talk about how he sees cosmetic and makeover culture as part of the new global economy.

First though, have you ever sat down and talked to a cosmetic plastic surgeon? Bryan Mendelson runs the centre for Facial Plastic Surgery in Melbourne, he’s a past president of the International Society of Aesthetic Plastic Surgery and now the author of In your Face – the hidden history of plastic surgery and why looks matter.

Bryan we’ve just had the winner of the Archibald announced the other day. I guess it’s no surprise that far and away our most famous art prize is for a portrait.

Bryan Mendelson: Yeah. What’s also interesting I find is, there’s a National Portrait Gallery but not a national body gallery, not a national leg gallery. It’s because the face tells a story: the identity and the history of that person. Looking at portraits you see so much.

Amanda Smith: Yes, of course. Unlike even other primates our faces can deliver the most complex and the most subtle messages. I can tighten my lips slightly now and you can read what that means. You raise an eyebrow – I know what that means. What is it that makes it possible for us to do these things with our faces?

Bryan Mendelson: It’s the higher development of the musculature. So for example in lower order species, even chimpanzees, most of the face is encased with muscle. Our muscles have developed more sensitivity, more control, more nervous innovation. And in areas that are not involved the muscle is diminished - so on the outer part of the cheek there isn’t any of that muscle. And this wasn’t really appreciated fully until 1976, when some French plastic surgeons were doing dissections and they realised that the middle layer of the face that contains the muscles is partly what’s called the aponeurotic (which is fibrous) and partly muscle. It’s called superficial muscular aponeurotic system, right across the face. And this really blew open the whole thinking about how do you do a facelift because before that time all faces were operating just under the skin and now there was this suggestion that maybe you should be operating under this SMAS layer.

Amanda Smith: SMAS! Kind of sounds like an acronym for a cold war intelligence organisation.

Bryan Mendelson: That’s right! So, it’s taken 30 years to figure out how to really utilise our understanding of the anatomy.

Amanda Smith: Well we’ll talk more about that later. But of course long before this kind of cosmetic surgery there’s a much longer history of fixing up people’s damaged faces isn’t there? In fact the history of facial plastic surgery goes back much further than you might think. Tell us about what’s known as the Indian method.

Bryan Mendelson: It does go back much further than you would expect. I mean it’s amazing to think that the first reported plastic surgery (it wasn’t called plastic surgery then of course) but it was in India, 600BC. And the Indian method was particularly used for building noses that had lost the tip. Because the tip of the nose doesn’t have bone in it, it’s easily lost by trauma or disease. So to rebuild the nose - because it’s a very ugly deformity, the absence of the nose - and to rebuild it you use the skin of the inner part of the cheek. So they would cut it away...

Amanda Smith: So they were actually taking skin grafts?

Bryan Mendelson: Well it wasn’t… You see with a skin graft you’re taking a whole piece straight off and then reimplanting it. It doesn’t work very well for thick tissue only for very thin. So skin grafting didn’t really occur until last century. But they were taking a flap: that’s the full thickness, leaving it attached at one end to keep the blood supply, transferring it across to the tip, sewing it so that it’s blending in with the normal surrounding tissue on the nose. The blood supply would gradually build up there in a couple of weeks, so much so that you could then cut off the blood supply coming from the cheek. So then you’ve got this piece of cheek on the nose and then you can mould it to a more attractive shape. That was the Indian method, very clever. And it’s been called the Indian method, right through until the Italian method came on the scene.

Amanda Smith: Yes, and the Italian method, this is like 2000 years later. So what’s the Italian method, this is something developed by Gaspare Tagliacozzi?

Bryan Mendelson: Tagliacozzi. Now, he was a professor of anatomy and surgery in Bologna. And Bologna is significant because that was the centre of medicine and teaching. It’s the oldest university in Europe. And so, he was of a school, he learnt this from his teachers but he was the one who popularised it because he published a book, which was a best seller. And so that book, in 1597, the first book on plastic surgery, went through several editions and there were pirated copy editions. That method involved using the arm to rebuild the nose. So you would raise a flap of skin on the upper arm, on the inner part of the upper arm. So there was no cutting on the face. The first stage would be cut three quarters the way round and then left there, so it would strengthen the blood supply coming from the base. Then, at a later operation, it would be lifted off and attached to the nose. The arm would be brought up to the head and the hand placed on the back of the head and fixed in place with a leather harness.

Amanda Smith: How long did you have to be like that for?

Bryan Mendelson: Several weeks. Imagine the stiffness of the shoulder. Imagine, even more than that Amanda, imagine going through this surgery without any anaesthetic, the risks of infection. The motivation for surgery is extraordinary…

Amanda Smith: You’d really be wanting a new nose.

Bryan Mendelson: This indicates that appearance is so important to people - what they would go through to look normal.

Amanda Smith: Bryan, when does the word plastic actually come into the terminology?

Bryan Mendelson: We don’t know exactly, Amanda. This is a fascinating thing for plastic surgeons but it seems like the word came in the early 1800s from von Graefe, who was German. Germany was very advanced in surgery in the early days and he translated an English article, it was about a nose reconstruction, von Graefe picked it up in his book Nasen Plastik. So that was the first use of the world plastic. It’s fascinating, I had plastic surgery when I was young and I assumed I had a plastic skin on my nose.

Amanda Smith: Indeed!

Bryan Mendelson: And I couldn’t understand why it was so good that I was perspiring through my nose. The word plastic actually comes from plastikos......

Amanda Smith: The Greek word for being able to be moulded or shaped – yeah.

Bryan Mendelson: That’s what plastic surgeons tend to do: mould the shape of the face.

Amanda Smith: So let’s talk about moulding the face to beautify rather than fix up damage or disease. There are actually a couple of extra layers under the face aren’t there that the rest of the human body doesn’t have. This was the big discovery that led to changing how you do facelifts. So tell me how they’ve changed?

Bryan Mendelson: In the early days and even the way I first trained, which was the end of the early days, surgery was simply lifting the skin off the face and then tightening the skin. And that in its day was rather remarkable. You know, Madame Noel in Paris in the 1920s. It was just phenomenal what she could achieve - because you had to control the skin tension, that was the key. And still to this day patients will ask how can you get one side the same as the other? But the answer is, with surgery, for proper plastic surgeons, is no longer working on the skin directly but operating beneath the support layer, beneath that SMAS.

Amanda Smith: SMAS - that’s what you were talking about earlier.

Bryan Mendelson: So again there are spaces under the SMAS. So the surgeon can access the spaces and then you go straightforward through the space without any bleeding at all, without any nerves. You’re effectively tightening the ligaments that hold the face in place. So the skin is not stretched tight, it’s retoned.

Amanda Smith: On RN you’re listening to The Body Sphere with Amanda Smith and we’ll hear more from Bryan Mendelson the plastic surgeon and the author of the book In Your Face in a bit.

But first I just want to throw this out to you. When did we start to equate beauty with ability? Maybe it’s always been the case but remember this from recent history.

Susan Boyle: I am trying to be a professional singer.

Judge: And why hasn’t it worked out so far Susan?

Susan Boyle: I’ve never been given the chance before, but here’s hoping it will change.

Song: I dreamed a dream......

Amanda Smith: That clip of Susan Boyle on Britain’s Got Talent went viral because it was so astonishing - apparently - that someone so plain and un-designed could possibly be any good.

Anthony Elliott is a social theorist and director of the Hawke Research Institute in Adelaide. He’s written a lot about the rise and rise of cosmetic surgery and makeover culture and what’s driving it - most recently as part of his book Reinvention. Anthony, when did we start to equate beauty with ability? What’s the bigger picture?

Anthony Elliott: Look I think there’s a whole lot that’s bound up with that. One of the ways in which beauty has now become intricately interwoven with ability is it’s to do with one’s capacity to be ready for change. And I think this is what cosmetic surgical culture really signals to people. So what matters most is - it’s not really a question of whether a celebrity or a public figure may have had a nose job or collagen fillers and so on and so forth - what seems though to be of utmost significance is the fact that one has revised one’s looks, yeah, as a key designator of one’s ability, of one’s readiness, to engage with the challenges of such a fast changing world.

Amanda Smith: Well certainly an older face, an aged face is really by definition not a desirable look (and I have to admit with each passing day I find the idea of cosmetic enhancement less and less repellent). Why though are we so fearful of ageing, what are the factors at play in this day and age?

Anthony Elliott: Amanda I’ve interviewed many middleclass professionals and senior professionals into late middle age that have either been retrenched, or have been deeply troubled about how their older appearance is marring their opportunities at work, or limiting their opportunities, or completely closing down their opportunities. Through my research I found that more and more middleclass professionals and executives are turning to cosmetic surgery in an effort to retain or sometimes to acquire more youthful looks. In a sense I think it’s not too surprising. I mean, we’re now in a new economy of endless downsizings, short term contracts, just in time deliveries and multiple careers. So I think there’s a set of very deep institutional forces here: forces to do with the advent of the global electronic economy which are in a sense (and this is no doubt a stretch) but my argument is that this new economy is actually spawning experiments in living, if I can put it that way. Women and men now are trying on and trying out experiments with their body that were previously unavailable to previous generations - all in an attempt to develop a career edge.

Amanda Smith: Well you know how they say that 40 is the new 30 and 50 is the new 40. And maybe it is if you’ve had work, because otherwise in a way 50 is more like the new 60, isn’t it, as far as your employability goes in this competitive world that you’re describing?

Anthony Elliott: There’s one woman who I interviewed for a previous book on cosmetic surgery who referred to the touch up, they were her words, the touch up that she had undergone. It was actually an elaborate process of cosmetic surgical intervention. She wanted to, really, undergo a process I guess of age rewind in order to be less noticeable, not wanting to stand out in terms of the ageing process. So I think there are very many different motivations that people have for undergoing the surgeon’s knife. And really I’m making a plea for a more sophisticated understanding within society as to what it is that’s driving people. And what’s prompting people to want to undergo what, not that long ago, would have been considered a very, very drastic intervention into one’s own life.

Amanda Smith: And skin…body…

Anthony Elliott: Exactly. And, in fact procedures that they previously would never have thought about undergoing.

Amanda Smith: With the generally increased availability and acceptability of cosmetic surgery, is there also something of the idea of being self made in this? You know self made, as in someone who’s pulled themselves up by the boot straps to make a go of their lives? Does this attitude now perhaps apply to your face, to your body as well - that you may not have much to start with but you can make something of it?

Anthony Elliott: Absolutely. The new economy, the corporate message, or rather the corporate ethos which is increasingly dominant is one that requires women and men to pull themselves up by their own boot straps and get on with the job of reconstructing, recalibrating, reorganising. The body is a site for such reinvention par excellence. So again it’s not surprising that we are now in a world, in a culture (and I say we, I mean this is still obviously very much still a world of the expensive cities of the west but it has a globalising logic) we are now in a world where bodies are routinelyplucked and pummelled and stitched and shrunken and recast.

Amanda Smith: On air and online this is The Body Sphere, Amanda Smith with you. And, you know, there’s a saying about “having a great face for radio”. Hooray!! But I do find it interesting: that argument that a facelift has become a kind of metaphor for being willing and able to change and adapt at work. The plastic surgeon Bryan Mendelson says, though, that nobody wants to make it obvious.

Bryan Mendelson: Almost universally the patient will say I don’t want it to be detectable otherwise I won’t have anything done. I just want to look fresher, I just want to look good for my age. And then my answer to them is, well, the surgery is going to take off, whether it’s 5 or 8 years, depending on how aged they are almost straight away. But then the real advantage of the surgery is that in the future, because you’ve tightened the internal ligaments, it’s going to slow down the rate of future ageing. Because ageing is exponential it’s not linear. You don’t age a little bit each year, the rate of ageing changes and people notice that. They’ll say the last year, you know, I can’t believe I’ve aged 5 years. That’s how it seems to them.

Amanda Smith: What’s wrong with ageing?

Bryan Mendelson: Well patients tell me things like, I don’t mind ageing but I can’t stand my face looking old. Because you’re treated in a different way. And you look a different way. When you look in a mirror and what you see is not satisfying - in fact, a lot of people will come along as a result of an incident. Often they are walking along the street and they’ll look in a shop window and see an old lady come towards them and say, my God, that’s me. Or - passport photograph, driver’s licence photograph - often the photographs a terrible quality photograph and it makes them look worse than they really are. But once they’ve had that perception change, it frightens them.

Amanda Smith: When someone has had, say, a nose job or a facelift can you tell? Can you tell which surgeon has done the job? You know, is there a sort of sameness, a look?

Bryan Mendelson: If you have had a good facelift, even a colleague can’t pick it, just can’t pick you’ve had a facelift. Now, I can pick a lot of surgeons’ work. I can pick - there are quite a few surgeons around who like to do brow lifts, when I think you shouldn’t be doing a brow lift because younger people don’t have high brows - but brow lifts have been very fashionable. Noses – I always remember a lady who came to see me. She said, ‘I was walking along the street and I saw a woman walk the other way who had an identical nose to mine. And I was horrified to think that we both had that surgeon’s signature nose’. And she wanted it to be neutralised. The ideal nose is not the ideal textbook ideal, it’s what suits the face. That’s where the artistry comes into cosmetic surgery. But if you go to Dallas, for example, that’s been a big teaching centre in rhinoplasty in the last 10/20 years. They talked about the proportions and how the tip of the nose should be somewhat exaggerated…

Amanda Smith: Retrousse?

Bryan Mendelson: Retrousse, but still with a higher bridge and a narrow nose. And I’ve been to Dallas and gone to a bar there and all the women are sitting with these noses. You know you’re in Dallas.

Amanda Smith: Well now, you’re dealing with individuals who come to see you for help. They’re you professional responsibility. But on a wider social level, how do you think about what you do? Are you - and I mean here the collective you, aesthetic plastic surgeons - are you responding to a demand or are you creating a demand?

Bryan Mendelson: I don’t think we’re creating the demand, the demand has been there. But because, you know there is the availability of fillers and neurotoxins, we call it, botox. I don’t like to see all these younger people having fillers and botox personally, because we’re not even going to know what’s an actual face. You know in Seoul in Korea it’s epidemic. It’s this Gen Y thing, the younger people they are wanting a stylised look.

What you’re really asking is where are we leading society I think. I’m not sure, because I expect there’s going to be a swing back to natural.

Amanda Smith: Do you? Because fake’s kind of in at the moment.

Bryan Mendelson: Certainly, I was invited to Brazil to do a live demonstration facelift.

Amanda Smith: That’s like the old days of the anatomy lesson.

Bryan Mendelson: Yeah, well you do demonstration surgery, that’s how surgeons learn. And then I was told just before the start that well, in Brazil people like a tight look. Whereas the thing I’ve worked for all these years is a natural look. But I think they like it because it’s a bit of a status symbol, like in Los Angeles.

Amanda Smith: Within the wider world of surgery, of plastic surgery, how are those of you who do specialise in the aesthetic - beautification I suppose as opposed to fixing up disorders or disfigurements - how have you been regarded within the wider profession?

Bryan Mendelson: Historically, for a surgeon to be seen to be going out and doing cosmetic surgery in front of his colleagues, the neurosurgeons and orthopaedic surgeons, was almost an embarrassment. And certain surgeons - we used to say went over to the dark side and would specialise in cosmetic surgery - often they were rather flamboyant characters, a little bit less respectful of the institution of medicine. So this was the sort of ‘60s type cosmetic surgery. Now, it’s come back into respectability because we understand anatomy, often as much, if not leading the understanding of anatomy to the reconstructive surgeons.

Amanda Smith: Do faces fascinate you? Do you have a particular interest in faces?

Bryan Mendelson: Oh yes, because of the animation of the face, you know, there’s no doubt that’s the real fascination. And I just love the anatomy. You know when you operate and you get down into the facial spaces. You feel like you’re an explorer. You’re the first person who’s ever been there. And then you gently probe your way through and with all the experience and the techniques, you just open up these spaces in front of your eyes. It’s a beautiful thing, because you’ve got control. And we never had that before. It’s not easier surgery than other surgery. But now, I think I’m just as fascinated by what it does for people. It’s absolutely absorbing.

Amanda Smith: And Dr Bryan Mendelson as well as being an aesthetic plastic surgeon is the author of In Your Face – the hidden history of plastic surgery and why looks matter.

Returning to the sociologist Anthony Elliott - I’ve always been struck by how when a person gets a facelift or a nose job or their lips plumped up it’s called ‘work’, they’ve ‘had work done’.

Anthony Elliott: Yeah and that tells us a great deal. There are many people that feel it’s celebrity culture, it’s the spread of programs like The Swan and 10 Years Younger and the endless reality TV programs that’s driving this. I mean I myself think that’s far too simple. Others have argued that what we’re seeing is the reign of a rampart consumerism. So that what we have today really is a kind of instant generation, a plastic generation - that people now regard the purchase of botox or dermal fillers or breast implants as on a par with the purchase of a new designer handbag for example. I think that both of those arguments go clearly some distance in accounting for what’s driving people to undergo the surgeon’s knife but myself I think there’s much more at stake than just that. What we’re seeing is to do with the emergence of new personal vulnerabilities. It’s to do with a world of increased disposability where people, individuals, women and men are themselves feeling increasingly disposable. So cosmetic surgery and the makeover industries offers a very powerful fantasy and a very powerful possibility through reinvention, to get yourselves out of these very alarming anxieties.

Amanda Smith: And as you say, to stay in the game, professionally and personally.

Anthony Elliott: And it’s staying in the game here, it’s demonstrating that one is a player (not just to your family but to your employer, to fellow employees) that if one is ready to embrace flexibility, plasticity, liquidity then, against this backdrop as I said, this institutional backdrop of a world of just-in-time deliveries and multiple careers and the corporate downsizings, at least you’re representing yourself as a player, as being ready to embrace this whole brave new world.

Amanda Smith: And Professor Anthony Elliott is the author of Making the Cut and Reinvention and he’s the Director of the Hawke Research Institute at the University of South Australia.

Song: The Tracks of My Tears.

You gotta say there’s a certain ugh, is it irony, to Dolly Parton singing those lyrics. But then again she’s savvy enough to know that.

I’m Amanda Smith. Interested of course to hear your thoughts. You can post a comment to the website and you can download or stream this program from there too as well as find details for the books I’ve mentioned – abc.net.au/radionational/bodysphere

Guests

Dr Bryan Mendelson

Facial plastic surgeon; author of In Your Face

Professor Anthony Elliott

Director of the Hawke Research Institute, University of South Australia; author of Making The Cut and Reinvention

Publications

Title

In Your Face: The Hidden History of Plastic Surgery and Why Looks Matter

Frank :

25 Mar 2013 11:51:48am

Now...in Korea, teenagers are having "PLASTIC" (this word explains it all I should think)surgery to look like pop stars. Is there anything less "intelligent" about this than those who simply want to look younger? I'd say not....both are too....way too preoccupied with their notions of what they appear to be like! A young and very already beautiful girl died in China after extensive surgery to look....Mmmmmm better!. Her name was Wang Bei...and to read about the circumstances of her death it's like a Sci-Fi horror movie! In fact there are many people dying every day because they've basically been brain-washed into thinking they need to LOOK better to BE better! But there's something more!! It's something that Western cultures are answerable to and responsible for! I mean put "Plastic Surgery in Japan" into Google and you will get "US Certified Plastic Surgeons in Tokyo" Mmmmmm It's a very ugly "Western" thing then....I guess you can disagree! We could of course go on about how the west has intruded on Collectivist cultures like Japan! We now see the west going wrong in so many ways..........The notion of "self esteem" really needs to be looked at in western culture. What the ever happened to real notions of "beauty"....Seems to me the whole world is about as fake as monopoly money! Nothing is what it seems.......lies, lies, lies! Not good for a race which is supposed to be so "intelligent"!

Georgy :

25 Mar 2013 5:20:15pm

I listened with a growing sense of both disengagement and sympathy with the discussion of plastic surgery and the blurring of issues concerning self esteem and external pressure. I am 53 and an acutely aware that as a job seeker my age is actively against me, I note that they still ask age on forms and of course CVs give this away directly or indirectly. I therefore can understand the need to "look good for your age" but suspect that the issue lies with both men and women - men often want a "younger model" after a few years as this maintains their masculinity: an self image of themselves as attractive.... and women are complicit. They judge each other harshly on both looks and accessories and in my experience find individuality outside their own norms threatening . I am fiercely independent and reflective and cannot fathom why people want to look like clones of each other, as if their own skin is not good enough especially younger ones but assume this about belonging and fitting in. I wonder what would happen if we were all sightless - would we be judged on the tone of our voice instead or our accent leading us all to then speak the same? I find it hard not feel I am in turn judging people who are not able to be themselves and think that bigger boobs or fuller lips make them the person they should have been. I still remember the last film scenes in Death in Venice when von Aschenbach dies with hair dye running down his ruined face...

Jo Moulton :

25 Mar 2013 6:31:49pm

Amanda, you are on THAT subject again which raises my hackles. Dr Bryan Mendelson is a plastic surgeon with a book to sell and a business to promote. He is full of spin. You were provocative in your interview which brought this out well. When you re-visit this subject, and I'm sure that you will, could you please counter today's interviews by further exploring the feminist critique on plastic surgery You might like to google: Plastic Surgery - A Feminist Primer. It is worth a thorough read. You probably have, already! I recommend it as a reference that teases out the broader context for this discussion encompassing sexism, racism and ageism and the complexities within the feminist dialectic on plastic surgery.

Martin Olsen :

22 Jun 2013 3:20:08pm

This is a good trivia in knowing the origin of facial surgery.Now a days facial surgery in demand in the entertainment or those who are very particulate in beauty. And we all know that indulging this is need an extra budget of money and its up to us what is our priority. All I can say that aesthetics surgeons are only responding the demand of the consumer.Thank you.